Facial Dermatitis Research Articles

535 New regional dermatoses during dupilumab therapy for atopic dermatitis

Dupilumab is a monoclonal antibody targeting IL-4Ra used for treating atopic dermatitis (AD). A subset of AD patients develops new regional dermatoses (NRDs) on dupilumab therapy. Apart from limited case reports and series, little is known about these NRDs. We conducted a retrospective cohort study at a single academic site to describe the prevalence, clinical features, and management of NRDs among all adults treated with dupilumab for AD. NRDs were defined as eruptions that (1) occur in a new anatomic region, (2) be resistant to usual topicals used, (3) occur on uninterrupted dupilumab therapy, (4) occur following primary therapeutic response, and (5) not be explained by a different entity. Following institutional review board approval, a clinical data warehouse was queried for all adults receiving dupilumab for AD prior to November 1, 2018. 73 patients were included for analysis, of which 17 (23%) had NRDs. 14 had facial rash and 4 had a history of patch test-confirmed allergic contact dermatitis (ACD). The predominant morphologies were eczematous (12/17) and erythema (4/17). Most (11/17) were treated with topical corticosteroids. Four stopped dupilumab due to NRDs. Two NRDs were biopsied: one showed rosacea and the other showed resolving VZV. Two patients with NRDs had negative patch testing to at least 80 allergens within 2 years prior to starting dupilumab. New facial dermatitis while on treatment with dupilumab has been reported and suspected to represent unrecognized ACD. However, ACD likely does not explain all cases, as 2 patients with NRDs in this cohort had negative comprehensive patch testing. Unmasking of another primary dermatosis in an altered cutaneous immune milieu may explain the facial erythema seen in 4 subjects, one of whom had biopsy-proven rosacea. The retrospective study design and lack of diagnostic workup for most NRDs are weaknesses of this study. Larger studies involving biopsy and patch testing are needed to establish their etiology.

Contact allergy to methylchloroisothiazolinone/methylisothiazolinone in north-eastern Italy: a temporal trend from 1996 to 2016.

Methylchloroisothiazolinone (MCI)/methylisothiazolinone (MI) (Kathon® CG) is a common preservative used in industrial products, owing to its strong biocide effect. Contact allergy to MCI/MI has been reported in different occupations, including mechanics, hairdressers and healthcare workers. To retrospectively analyse the temporal trend of MCI/MI sensitization in north-eastern Italy and to evaluate the associations with occupations in our geographical area. From 1996 to 2016, 27381 patients with suspected allergic contact dermatitis were patch tested in eight departments of Dermatology or Occupational Medicine in north-eastern Italy. Individual characteristics were collected through a standardized questionnaire. The overall prevalence of MCI/MI sensitization was 4.2%, with the highest prevalence found in women and in patients younger than 25years. MCI/MI sensitization was significantly associated with atopic eczema (OR: 1.34, 95% CI: 1.10-1.70), hand/forearm dermatitis (OR: 1.20, 95% CI: 1.05-1.36) and face dermatitis (OR 1.30, 95% CI: 1.10-1.40). There was a significant association between MCI/MI sensitization and chemical processing workers (OR 1.74, 95% CI: 1.03-2.94), while mechanics and healthcare workers resulted more sensitized to this hapten only in the last 3years. Sensitization to MCI/MI is rising in the last years in Triveneto region, the 'epidemic' of sensitization to MCI/MI is mainly driven by extra-occupational dermatitis, and sensitization in some occupational groups is emerging only in the last years. A full labelling is compulsory for all products that contain isothiazolinones, to permit to identify the culprit agent.

Black tea dressings – a rapidly effective treatment for facial dermatitis

Background: Facial dermatitis is a common dermatologic condition. It is usually treated with either topical corticosteroids or calcineurin inhibitors. However, the use of these drugs is limited by side effects, including skin atrophy, local immunosuppression and possible oncogenicity.Objective: The aim of the study was to evaluate the use of wet dressings with black tea for treating facial dermatitis.Methods: We performed a prospective, open, uncontrolled before-after study enrolling 22 patients with atopic or contact facial dermatitis who were treated with black tea dressings and an emollient cream over 6 days. Disease severity was assessed using the (1) Facial Eczema Area and Severity Index, (2) Visual analog scale for pruritus, (3) Investigator`s Global Assessment score, and (4) Patient’s Self-Assessment score. The study was registered at www.ClinicalTrials.gov as NCT02941432.Results: A dramatic and highly significant reduction of all four disease activity scores occurred within the first 3 days of treatment and the patients continued to improve between days 3 and 6. No side effects were observed.Conclusion: Black tea dressings represent an effective treatment option for facial dermatitis. Its advantages include lack of side effects, low cost, and easy availability.

Contact dermatitis and sensitization in professional musicians.

Professional musicians have prolonged and intense physical contact with their instruments. This can lead to occupational skin diseases, particularly irritant and allergic contact dermatitis. To assess the skin diseases and sensitization patterns common among professional musicians. A retrospective analysis of the data of the Information Network of Departments of Dermatology (IVDK) was performed, including data from 1997 to 2017. We identified 236 professional musicians. In this group, male sex (58.6%) and younger age (60.6% aged < 40 years) were common. The musicians suffered more frequently from facial dermatitis (23.7% vs 15.7%) and less often from leg dermatitis (5.1% vs 10.7%) than the control group (the non-musicians in the IVDK database). The most frequent diagnoses were allergic contact dermatitis, atopic dermatitis, and irritant contact dermatitis. The sensitization profile of the professional musicians was similar to that of the control group. In 8.9% of cases, an occupational background of skin disease was confirmed. Severe occupational skin diseases among professional musicians are not as common as in classic "skin-damaging" professions. However, as these skin conditions can mostly be controlled with simple preventive measures, we recommend that this group should be patch tested and treated by a specialist.

从“玄府”理论探讨清营解毒汤治疗面部激素依赖性皮炎

从“玄府”理论探讨清营解毒汤治疗面部激素依赖性皮炎

Effect of Topical Steroid-Dependent Facial Dermatitis on Quality of Life: A Hospital-Based Cross-Sectional Study Using DLQI.

Background:The rampant, disturbing, and dismal unrestricted use of topical corticosteroids on face results in steroid-induced dermatitis termed topical steroid-dependent face (TSDF). It is an embarrassing and irritating condition for a patient. There is paucity of data from India regarding the effect of TSDF on the quality of life (QoL) of such patients.Aims:The aim of this study was to study the effect of TSDF on the QoL of patients with the help of a validated, easy-to-use, and reproducible dermatology life quality index (DLQI).Methods:A cross-sectional study was done among the outpatients seeking treatment for TSDF at a tertiary care hospital of a medical college. Patients were administered Hindi questionnaire version of DLQI. Controls were apparently healthy age- and sex-matched individuals.Results:DLQI scores revealed that TSDF had some effect on QoL in 98.11% of study patients. Study group had a mean DLQI score of 11.49. Statistically significant higher DLQI scores were recorded among females, patients aged <20 years and those who had no formal education/illiterate.Conclusions:TSDF affects QoL in majority of patients and it has a very large effect on the QoL in more than one-third of the patients.

Contact Dermatitis to Cosmetics.

Allergic contact dermatitis (ACD) to cosmetics is extremely common-probably the most common reason patients present for patch testing. The diagnosis should initially be suspected based on the patient history and the distribution of the dermatitis. Once the diagnosis is suspected, empiric recommendations for low allergenicity products should be implemented until patch testing is performed. The face is exposed to greatest number of cosmetics, and as a result, facial dermatitis is the prototypical presentation of cosmetic contact dermatitis. In particular, the eyelids are frequently involved, with common sources including shampoo, conditioner, facial cleansers, makeup remover, mascara, nail polish, acrylic nails, makeup sponges, eyelash curlers, and allergens transferred from the hands. Other typical facial distributions include lateral facial dermatitis, central facial dermatitis, and generalized facial dermatitis, each with its own unique set of most likely causes. Lateral facial and/or neck dermatitis is often a "rinse-off" pattern, with shampoo and/or conditioner rinsing down over these areas. Central facial dermatitis, when due to ACD, can be due to gold being released from gold rings and contaminating makeup foundation or to ingredients in moisturizers, wrinkle creams, topical medications, or makeup. Sparing of the lateral face is largely due to the fact that patients are more assiduous about applying the aforementioned substances to the central face than to the lateral face. Generalized facial dermatitis should trigger consideration of airborne contactants, facial cleansers, makeup foundation, and moisturizers and medications that are being applied confluently. Once adequate patch testing has been performed, there are a number of extremely helpful resources to help patients find products that are safe for use, such as the American Contact Dermatitis Society's "Contact Allergen Management Program" app.

54-year-old male with recurrent facial dermatitis with papules and vesicles on the extremities : Preparation for the medical specialist examination: Part 26

54-year-old male with recurrent facial dermatitis with papules and vesicles on the extremities : Preparation for the medical specialist examination: Part 26

Tertiary prevention of occupational skin diseases: Prevalence of allergic contact dermatitis and pattern of patch test results.

Allergic contact dermatitis (ACD) is one of the most common occupational skin diseases (OSDs). Its prevalence and the causative allergens differ between occupations. To evaluate the prevalence of ACD and the pattern of patch test results of patients taking part in a tertiary individual prevention programme (TIP) for OSD in Germany. In a retrospective cohort study, the data of 3411 TIP patients patch tested between 2007 and 2016 were analysed. In 2687 (78.8%) patients, work-related skin disease was diagnosed, mostly hand dermatitis. The highest proportion of face dermatitis was seen in painters (8.1%). ACD was most common in painters (56.8%), hairdressers (45.8%), construction workers (31.5%), gardeners/florists (26.7%), and metalworkers (26.5%). On average, hairdressers had the youngest age (31.4 ± 12.6 years, P < 0.0001) and the shortest time in the profession prior to the TIP (mean 13.7 years). The pattern of patch test reactivity showed occupation-specific differences related to work exposures. Identification of occupational groups at risk for ACD and relevant allergens may help in the development and implementation of targeted prevention strategies. Our data suggest that there should be a particular focus on hairdressers and painters.

Quantitative analysis of the therapeutic effect of topical medication for seborrheic dermatitis

Fifty one female outpatients with facial seborrheic dermatitis attending in Xuanwu Hospital during February 2016 to July 2016 were randomly assigned in two groups: 28 patients were treated with hyaluronic acid gel (study group) and 23 patients were treated with tacrolimus ointment (control group) for 28 days. The improvement of symptoms after treatment was observed by a questionnaire, and VISIA was used to quantify the skin index of the patients. There was no difference in the therapeutic effect between the study group and control group after 28 days (P>0.05). The facial spots and red areas were decreased in both groups, compared to those before treatment (P<0.05). The results indicate that hyaluronic acid gel is safe, non-irritating and effective in treatment of seborrheic dermatitis, and VISIA provides an objective and effective method for assessing the skin lesions seborrheic dermatitis. Key words: Dermatitis, seborrheic; Gels, hyaluronic acid; Tacrolimus

Facial dermatitis caused by undeclared methylisothiazolinone in a gel mask: is the preservation of raw materials in cosmetics a cause of concern?

Facial dermatitis caused by undeclared methylisothiazolinone in a gel mask: is the preservation of raw materials in cosmetics a cause of concern?

Allergen specific IgE determination by in vitro allergy test in head and facial feline dermatitis: A pilot study

Pruritus is one of the most common clinical findings in cats which have hypersensitivity on head and face regions. The purpose of this small pilot study was to verify underlying causes of pruritus in cats with head and facial dermatitis by using in vitro Veterinary Polycheck allergy tests which specifically detect Immunoglobulin E (IgE) concentrations against 20 different allergens. Ten cats were introduced to the clinic with varying degrees of head and facial dermatitis along with primary/secondary skin lesions and pruritus. At first, haematological, parasitological, microbiological and clinical examinations were performed. Six healthy cats without dermatitis (neither infection nor hypersensitivity) were also evaluated as a control group. Afterwards, 0.2 ml of blood was taken from all cats for specific IgE analysis against 20 different allergens. Regarding allergen specific IgE levels (kU/l) in cats with head/facial dermatitis and in healthy cats, in vitro tests gave a positive reaction most frequently against flea, Acarus siro, D. farinae, Ragweed (Ambrosia), Lambs quarter and Tyrophagus. There was a statistical significance between two groups for all allergens as follows; Lepidoglyphus (p=0.031), Alternaria/Cladosporium (p=0.011), Stinging nettle (p=0.011) Lambs quarter (p=0.031), Sorrel (p=0.003) and flea ( Ctenocephalides ) (p=0.031). In the present study, all positive reactions on the Polycheck test were thought to indicate underlying allergens of facial/head dermatitis in cats. It has to be mentioned that, in vitro allergy tests cannot be used as a sole method for distinguishing hypersensitivity from healthy cats due to the clinically irrelevant findings regarding morphology in healthy cats. Positive reactions in healthy cats might indicate a subclinical hypersensitivity state or the requirement for investigating other relevant factors.

Radiation Effects of Mobile Phones and Tablets on the Skin: A Systematic Review.

Background Skin health has become a worldwide concern. Most of the studies investigated the effect of mobile phone radiation on DNA and animals, but a few studies were carried out about skin diseases in mobile phone and tablet users. Few systematic studies have examined the relationship between mobile phone exposure and skin diseases. Methods We evaluated the association between mobile phones and tablets and skin diseases. We checked databases including PubMed, Scopus, Springer, Cochrane, and Google Scholar from 1995 to 2013. The eligibility criteria were descriptive, and observational studies were in English and Persian language, and the subjects were of all ages and reported skin disease. Results Most of the studies focused on signs and less on skin cancer. In total, 6 studies were included with 392119 participants with age over 25 years. In a nationwide cohort study in Denmark for BCC, the IRR (incidence rate ratios) estimates remained near unity among men and women. In the other studies, they reported an increase in temperature, hypersensitivity of warmth, facial dermatitis, angiosarcoma of the scalp, and burning sensations in the facial skin after mobile phone use on the exposed side and more within the auricle and behind/around the ear. Conclusions Overall evaluations showed that the level of evidence associated with the effects of radiation from the mobile phone and tablet on the skin is poor. This review shows a necessity for more studies in this area.

Efficacy and Tolerance of a New Non-Steroidal Prescription Cream in the Treatment of Mild Facial Seborrheic Dermatitis

Abstract Not Available

Skin as a marker of general feline health: Cutaneous manifestations of infectious disease.

This review is aimed at veterinarians who treat cats and especially those with an interest in feline dermatology. Tables are included to allow the reader to formulate a concise list of differential diagnoses for clinically similar presentations. The diagnostic approach to a case of ulcerative facial dermatitis is reviewed in a Case Notes quiz. Evidence base: This article includes up-to-date information regarding dermatologic manifestations of less commonly encountered feline cutaneous infectious diseases. Information has been drawn from the published, peer-reviewed literature and the most recent textbook chapters with a particular aim of describing and differentiating clinical lesions and the diagnostic approach to cutaneous disease, especially in unusual cases.

A Mouse Model of Anaphylaxis and Atopic Dermatitis to Salt-Soluble Wheat Protein Extract

Background: Wheat allergy and other immune-mediated disorders triggered by wheat proteins are growing at an alarming rate for reasons not well understood. A mouse model to study hypersensitivity responses to salt-soluble wheat protein (SSWP) extract is currently unavailable. Here we tested the hypothesis that SSWP extract from wheat will induce sensitization as well as allergic disease in mice. Methods: Female BALB/cJ mice were weaned onto a plant protein-free diet. The mice were injected a total of 4 times with an SSWP (0.01 mg/mouse) fraction extracted from durum wheat along with alum as an adjuvant. Blood was collected biweekly and SSWP-specific IgE (SIgE) and total IgE (TIgE) levels were measured using ELISA. Systemic anaphylaxis upon intraperitoneal injection with SSWP was quantified by hypothermia shock response (HSR). Mucosal mast cell degranulation was measured by the elevation of mMCP-1 in the blood. The mice were monitored for dermatitis. Skin tissues were used in histopathology and for measuring cytokine/chemokine/adhesion molecule levels using a protein microarray system. Results: Injection with SSWP resulted in time-dependent SIgE antibody responses associated with the elevation of TIgE concentration. Challenge with SSWP elicited severe HSR that correlated with a significant elevation of plasma mMCP-1 levels. Sensitized mice developed facial dermatitis associated with mast cell degranulation. Lesions expressed significant elevation of Th2/Th17/Th1 cytokines and chemokines and E-selectin adhesion molecule. Conclusion: Here we report a mouse model of anaphylaxis and atopic dermatitis to SSWP extract that may be used for further basic and applied research on wheat allergy.

Near-infrared light combined with tacrolimus ointment for the treatment of facial glucocorticoid-dependent dermatitis: a randomized controlled trial

Objective To evaluate the efficacy and safety of near-infrared light combined with tacrolimus 0.1% ointment in the treatment of facial glucocorticoid-dependent dermatitis. Methods A total of 68 patients with facial glucocorticoid-dependent dermatitis were enrolled from Department of Dermatology of Yantai Yuhuangding Hospital between December 2014 and December 2015, and randomly and equally divided into treatment group and combination group by a random number table. The treatment group was treated topically with tacrolimus ointment twice a day for 4 weeks. Besides the treatment with tacrolimus ointment, the combination group was irradiated with near-infrared light once a week for 4 sessions. After 4-week treatment, improvement in clinical manifestations such as itching and burning sensation was evaluated, so was the therapeutic effect. Results The combination group showed significantly higher response rate (85.3%[29/34]) compared with the treatment group (61.8%[21/34], χ2= 4.84, P < 0.05) . Additionally, response rates for itching and burning sensation, erythema, scales and papules were all significantly higher in the combination group than in the treatment group (χ2= 4.84, 6.35, 8.42 and 5.52, respectively, all P < 0.05) . Conclusion Near-infrared light combined with tacrolimus ointment is effective and safe for the treatment of facial glucocorticoid-dependent dermatitis. Key words: Dermatitis; Face; Spectroscopy, near-infrared; Tacrolimus ointment; Dermatitis, hormone-dependent

Controversies about the diagnosis of facial dermatitis

Controversies about the diagnosis of facial dermatitis

Cosmetic Allergen in the Past and Present

For almost 20 years after the end of World War II, many Japanese women were challenged by a dark secondary hyper pigmentation on their faces. The causation of this condition was unknown and incurable at the time. However this symptom became curable after a number of new cosmetic allergens were discovered through patch tests and as an aftermath, various cosmetics and soaps that eliminated all these allergens were put into production to be used exclusively for these patients. An international research project conducted by seven countries was set out to find out the new allergens and discover non-allergic cosmetic materials. Due to these efforts, two disastrous cosmetic primary sensitizers were banned and this helped to decrease allergic cosmetic dermatitis. Towards the end of the 20th century, the rate of positives among cosmetic sensitizers decreased to levels of 5% - 8% and have since maintained its rates into the 21th century. Currently, metal ions such as the likes of nickel have been identified as being the most common allergens found in cosmetics and cosmetic instruments. They often produce rosacea-like facial dermatitis and therefore allergen controlled soaps and cosmetics have been proved to be useful in recovering normal skin conditions.

Grundlage der Behandlung ekzematöser Erkrankungen im HNO-Bereich

According to Coombs and Gell, cell-mediated immune responses belong to type IV reactions and are borne mainly by T lymphocytes. The eliciting allergens are usually so-called haptens. Haptens are substances which develop to whole antigens only by binding to protein carriers. In otorhinolaryngology, delayed allergic hypersensitivities are apparent mainly as contact eczemata. Facial dermatitis, auricle and ear canal eczema as well as perioral eczema belong to the most common forms of contact dermatitis in ENT patients. The patient's medical history and morphology of the eczema give a strong indication for a proper diagnosis. Verification is carried out by patch test according to the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF, The Association of the Scientific Medical Societies in Germany) guidelines. Hereby the most widespread contact allergens are tested in a so-called "standard block", which can be reduced to an individualized allergen spectrum, based on medical history. For therapy, allergen avoidance is the most important measure which should also be applied prophylactically. Moreover, antiinflammatory treatment of the contact eczema is carried out with tapering topical corticosteroids. Depending on the patient's age, location and severity of the contact eczema, newer class II or III preparations should be chosen. Skin care preparations are helpful to reduce corticosteroid consumption and are indicated additionally after the acute phase treatment. An important differential diagnosis of contact eczema is atopic dermatitis. Whilst contact dermatitis experiences healing by avoiding the triggering noxious agent, genetically determined atopic dermatitis shows a chronic, recurrent course. In addition to topical corticosteroids, calcineurin inhibitors have been approved for treatment of atopic eczema. In all eczema diseases, regular skin care is a necessary measure which contributes mainly to barrier repair.